Tom Harkin

Mr. HARKIN

Mr. HARKIN. I will.

Mr. HARKIN. Well, the Senator asks an insightful question. Earlier, I had stated--and the Senator may not have been in the Chamber--my office has received over 700 phone calls. Only four have been in favor of this bill. I have not received one phone call from a drug company. Now, the Senator understands when we have legislation that impacts powerful industries in this country, and if it impacts them negatively, they are all out here. Our phones are ringing off the hook; lobbyists are in our offices; the private jets are parked at Dulles. They are all over the place. So it says to me that this bill must be a great benefit to the drug companies because I haven't heard one peep from them. I have found in my experience, I tell the Senator, in the House and in the Senate that when you see a large industry silent on a bill that impacts them so greatly, you can only come to one assumption: They must love it.

Mr. HARKIN. Mr. President, last week, I believe it was Friday, a number of amendments were laid down, one of them being an amendment that I offered. It is cosponsored by Senator Smith of Oregon. It has been sitting there all week. I have not had much of a chance to say anything about it. I thought, since there is a lull on the floor, I might take an opportunity to talk about that amendment and what it does, just so, when it comes up for a vote, I will not have to take a lot of time then to talk about it. The amendment, I would say at the outset, is exactly the same as President Bush requested in his 2004 budget but for one small change. President Bush's budget requested $350 million a year for 5 years, under Medicaid, to get people with disabilities out of institutions and nursing homes and into community living. The problem is that the cost of this to the States is very high for the first year. You can understand and appreciate, taking people out of an institution, out of a nursing home, means the State has to find housing; it has to find, perhaps, qualified personnel to help, maybe attendant services. So there are a lot of preliminary things a State has to do in order to provide for this transition from an institution to community-based living. Many States simply cannot afford it. The good news is that States want to do this because it has been shown, in the States that have done this already, they save a lot of money. It is much cheaper to have a person with a disability in a community-based or home-based setting than in an institution or a nursing home--much cheaper. In fact, in a couple or three States that have already done this, we have had savings of over $40 million or $50 million a year to those States. Again, the hurdle is that first year, getting people out of these institutions and into community-based living. What the President had requested in his budget was $350 million over 5 years as an enticement to States to do this. What the Federal Government would do is it would provide 100 percent of the funds per Medicaid beneficiary for that first year. After the first year, then the State would go back to the Federal/ State Medicaid match that the State had before. So, let's say a State had a 60/40 Federal/State match on Medicaid right now. During the first year, the State would have to come up with no money; the Federal Government would take 100 percent, would provide 100 percent. The State could use that money, then, that extra money, to set up community-based living systems for people and institutions and nursing homes. After that first year, then the State would go back to the 60/40 split it had before. That is what this amendment is. It is called ``Money Follows The Person,'' and that is what President Bush called it in his proposed budget also. What our amendment would do would be to provide, in the 5-year program, $300 million in the first year and then $350 million in each of the following 4 years. Then that would be the end of it. It would be 2004 to 2008. Again, it has been 13 years since the Americans With Disabilities Act was passed. We will celebrate that on July 26 this year. In the Americans With Disabilities Act, we as a Congress, as a country, said no to segregation of people with disabilities. The Americans With Disabilities Act said: We are going to integrate people with disabilities into our society. No longer are we going to exclude and segregate them. However, our Medicaid Program today, 13 years later, still says yes to segregation. Here is what I mean by that. Recent data indicates that 70 percent of Medicaid funds are spent on institutional care and only 30 percent to pay for community services. The thrust of our Medicaid spending today is for institution-based care. Our Medicaid system kind of flies in the face of the Americans With Disabilities Act in which we as a country committed ourselves to desegregate people with disabilities, fully integrating them in our society. I have been trying for the last 10 years to get this change made. It is a bipartisan effort. I am not the first to do this. Others have tried it also. I do commend President Bush for putting it in his budget proposal for this year. It is the right thing to do, and I commend the President for doing that. Now, again, I want to make it clear, this amendment is about choice. No one will be moved out of an institution who does not choose to be moved. This is not mandatory. Under this amendment, a State will be required to ensure that individuals and their representatives have the necessary information to make an informed choice as to whether they want to live in community-based situations or whether they would prefer to remain in an institution. Now, again, regarding the offset, our amendment is fully offset by a Medicare secondary payer provision that is supported by the Department of Justice and was included in the House bill. Mr. President, I have a letter, dated June 17, from William E. Moschella, Assistant Attorney General. It is to the chairman of the House Committee on Energy and Commerce, Congressman Tauzin. The letter states: This is to advise you of the Department's support for a provision in the Medicare Prescription Drug and Modernization Act-- Which we are about now-- set forth in Title III, Section 301, which would protect the integrity of the Medicare Trustee Fund by clarifying that Medicare must be reimbursed whenever another insurer's responsibility to pay has been established. The Section is consistent with the litigation positions taken by this Department and the Department of Health and Human Services in numerous court cases. So the Department of Justice, speaking for the administration, is in favor of this offset. Mr. President, I ask unanimous consent to have printed in the Record the letter from William E. Moschella, Assistant Attorney General.

Mr. HARKIN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. HARKIN. So again, we have an amendment that is exactly what the President had in his 2004 budget request. We have an offset supported also by the administration. So this is truly a bipartisan effort. This amendment Senator Smith and I have offered is widely supported by older Americans and people with disabilities. AARP, the Consortium of Citizens with Disabilities, ADAPT, the National Council on Independent Living, the National Council on the Aging, and the National Association of Area Agencies on Aging all support this amendment. Both parts of this amendment--the Money Follows Program and the offsets--are about fairness and justice. If this amendment is adopted, private insurers will pay their fair share of Medicare costs and people with disabilities will have the opportunity to live in their own communities. I will just talk about a constituent of mine, Ken Kendall. Ken was injured in an accident and has a serious spinal cord injury. When he lost his health insurance, he was forced to go on Medicaid, and his only choice was a nursing home almost 2 hours from his friends and family. Ken recently wrote to me that he went to dinner and a movie for his 30th birthday. No big deal, except he had not been to dinner and a movie in the 2 years since he went into a nursing home. He said: ``I was almost in tears. I felt like I had a real life again.'' This amendment would give people like Ken a real life again, and not just on their birthdays. Individuals with disabilities should not have to continue waiting to enjoy the opportunities all other Americans take for granted. So again, that is the essence of the amendment. Amendment No. 991, As Modified Mr. President, I ask unanimous consent that the amendment be modified with the modification I send to the desk. This is a modification to amendment No. 991.

Mr. HARKIN. Mr. President, all this modification does is it changes the first year, but it leaves everything else the same. This was $350 million each of the 5 years. This is now $300 million in the first year, and $350 million for each of the 4 years thereafter. So again, as I said, 13 years ago we passed the Americans with Disabilities Act. We said no to segregation of people with disabilities. Ever since that time, Medicaid still continues to segregate people. When 70 percent of their money goes for institutional care, and only 30 percent goes for community-based care, it is time to break that down and give people with disabilities the right to exercise their own choice about where they want to live. And that, really, is the essence of the amendment. I hope Senators will support the amendment overwhelmingly since, as I said, it was in the President's 2004 budget and the offset we have used is also fully supported by the administration. With that, Mr. President, I yield the floor and suggest the absence of a quorum.

Mr. HARKIN. I yield, without losing my right to the floor, to the assistant minority leader.

Mr. HARKIN. Does the Senator from Illinois think the drug companies are losing money on every bottle of pills a veteran buys? I can see him shaking his head. Obviously not. Veterans get their bottle of pills cheaper than anyone else. I bet my bottom dollar the drug companies are not losing a penny on any one of them. They are making money. They are just not making as much money as they are, say, if I went in and bought them. I yield for a question without losing my right to the floor.

Mr. HARKIN. Madam President, I do not think in my 19 years in the Senate we have faced a more important and decisive issue than what is before us right now. The action the Senate will take on this bill, I believe, will set us on one of two courses. If the Senate passes S. 1, as it is now constituted, and then goes to conference with the House--and the House bill is even worse than this one--we will have set this country on a course, inexorably, I believe, toward the privatization of Medicare and the privatization of Social Security. That is why I believe this upcoming vote is such a momentous vote. There are those who say: We can pass it--maybe it is better than nothing--and then we can come back sometime in the future and make it better and fix it. I am not certain that is a gamble I want to take with the future of Medicare and Social Security. The proponents of this bill are claiming that it is going to provide prescription drug coverage for seniors. Obviously, that is something we all hear about when we go back to our respective States--we know it; we sense it; we feel it; we see it--that more of our elderly are cutting their pills in half. They are not taking the prescribed medicine. They wind up in the emergency room of the hospital. Under Medicare, if one is in the hospital, they get their drugs paid for. But if they are outside and they need drugs to keep them healthy, to keep them out of the hospital, then there is no help. I hear this from our seniors all the time. So we know the need is there and that we should address it. We have been talking about it for a number of years. Quite frankly, I think the bill before us, S. 1, moves the focus from the elderly and their situation and their need for an affordable, reliable prescription drug benefit, to a special interest: What is best for the drug companies? What can we do to make sure that they can continue to make the high profits they are making; to continue to be able to advertise and push these drugs on people who may demand drugs for which they could use cheaper alternatives? The focus of this bill is a special interest focus to help the drug companies. I have gotten over 700 phone calls in my office. Only four of them were for this bill. Seven hundred phone calls from the elderly, and only four in favor of it. I cannot believe I am the only person getting these kinds of phone calls. Funny, I have not gotten one phone call from a drug company. They are very happy and very satisfied with this bill. So why do we find ourselves in this situation? Well, it is really only a matter of priorities. This administration and Congress had no qualms about passing enormous tax cuts amounting to $93,000 a year for millionaires and above, but now we have problems coming up with adequate funds for our Nation's seniors. This bill will not provide significant relief to the millions of seniors who need it. Let's put it in perspective. During the last 3 years, this Congress has passed, and the President has signed, $1.6 trillion in tax cuts. That is assuming we do not continue the cuts that are already scheduled to sunset. If we do not sunset these tax cuts, it is going to amount to a lot more than that. At the same time, we are told by CBO that seniors will have about $1.8 trillion in drug costs over the next 10 years. So do we have the picture? We have just passed $1.6 trillion in tax cuts, half of which benefit the wealthiest 1 percent in our country. Keep that figure in mind, $1.6 trillion. That is with the sunset provisions. Now, if we do not sunset them, it is going to be trillions more than that. CBO says over the next 10 years our seniors are going to need drugs costing about $1.8 trillion. We do not have the money for that. Why? Because $1.6 trillion has already gone out for the tax cuts. After breaking the bank on these tax breaks for the wealthy, we are left with table scraps for our seniors. It is all due to a bad budget that many of us did not support. I did not vote for this budget. It was a bad budget. We are going to see more about how bad this budget is when our appropriations bills hit the floor on education, health, and job training. We are going to see how bad this budget really was then. Some examples of how bad I believe the provisions of this bill are: A senior living on $15,000 per year--that is just right over 160 percent of the Federal poverty level--with $1,000 in annual drug costs will actually lose money if enrolled in this program. My colleagues heard me right. If a senior is making $15,000 a year, and they have $1,000 in annual drug costs, if they join this plan, they pay more in than they get out. In fact, it is estimated that at least 35 percent, more than a third of all Medicare beneficiaries, will lose money if they enroll in this plan. A married couple with a combined income of $20,000, again just slightly over the 160 percent of poverty level, if they had individual drug costs of $1,500 each--that is $3,000 a year in drug costs--they would save less than $400, barely 12 percent of their total drug costs. Even seniors with high drug costs will only get modest assistance. In fact, a senior under Medicare will have to have drug costs approaching $9,000 per year before this plan will even cover a half of their expenses. When we add together what a senior has to pay in premiums, deductibles, and cost sharing, then they have this coverage gap, the donut hole, where they do not get 50 percent coverage until they hit $9,000 in drug costs and then they get a 50/50 split--$9,000 in drug costs before they even get 50 percent. As I said, the plan has a donut hole, a gap, the coverage of the size of Texas, maybe Alaska. What this means for seniors is that they will pay 100 percent of their drug bill even while they are continuing to pay premiums, but they will not receive any drug coverage. Now, there is an eruption coming. When this bill passes and it gets out there and seniors finally get in this in a couple of years, there is an eruption coming because there are going to be seniors out there saying: Wait a minute, I am paying into this thing and I do not get anything back because I fall in this gap? Wait until my colleagues start hearing from their constituents on that one. Under this gap, once a senior's total drug costs reach $4,500, they are on their own until their catastrophic kicks in at $5,800, if I am not mistaken. But they still have to continue to pay premiums. Even though they pay for everything, they still pay the premiums. They are paying something, but they are getting nothing. That leaves a senior citizen with another $1,300 in out-of-pocket drug spending each year if they hit that gap. That is what we call the Swiss cheese model of drug coverage. It is full of holes, and woe to you if you fall in one of them. This bill provides too little to middle-class seniors. We tried to fix the problem. Senator Boxer offered an amendment to fill in this unfair coverage gap. The Republicans said: No, we cannot afford it. Oh, we can afford $1.6 trillion to the wealthiest in this country, but we cannot afford to close the coverage gap. Priorities, my friends, priorities. That is what this debate is about, priorities. The second flaw in the bill is it is a bureaucratic maze. Congress is trying to cram through one of the most significant changes in social policy in decades in 2 weeks. I am beginning to think it is because the leaders of this effort do not want seniors and the rest of the people in this country to see what is in the bill until it is too late. This is a complex, daunting, bureaucratic nightmare of a bill, and it will be for seniors. This weekend the New York Times headlined in red ``Criticism of drug benefit is simple: It's bewildering. High level of complexity causes concern.'' With both houses of Congress poised to pass a Medicare drug bill next week, lawmakers are increasingly anxious about the complexity of the legislation and its reliance on new and largely untested arrangements to deliver drug benefits to the elderly. This complexity, they say, may be daunting and confusing to beneficiaries, and even to insurance companies, which are supposed to manage the new benefits. Many lawmakers say they have just begun to examine the bill's intricate details and the web of political compromises behind those provisions. Senator Larry E. Craig, Republican of Idaho, lamented the bill's ``high level of complexity and prescriptiveness.'' Senator Hillary Rodham Clinton, Democrat of New York, said it would create ``a Medicare maze, a whole new bureaucracy.'' Yes, it is bewildering. It is complex. If you think reading the bill is complex, 654 pages, I bet there are not a handful in this room who know what is in the bill--maybe a few in the committee, not many more. If you think that is bewildering, wait until the seniors start getting hit with this. There is a reason why over the last several years when we put in Medicare+Choice for Medicare 89 percent of seniors chose to stay in traditional Medicare. Why? They want a simple, straightforward, understandable, reliable, guaranteed benefit, one in which they get coverage for the drugs they need, one they can sign up for and it does not put you in and put you out and put you in and put you out, year after year, but it is there solidly and one that is affordable. What they are going to get under this plan is a series of befuddling and bewildering steps just to obtain substandard drug coverage. Let's take an example. A senior citizen, we will call him Bob, next year is going to receive a drug card. Well, la-di-da, he will get a drug card. He might already have three or four drug cards in his wallet. In fact, I had an individual in Iowa a few weeks ago who took out his wallet and he already had five prescription drug cards: One from AARP, one from the State, one from a drug company, and a couple more I did not recognize. He said: Not a one is worth a hoot. Millions of drug cards are out there now from CVS, State programs, other private organizations, AARP. If discount cards provided anything, if they amounted to anything, they would not need a drug benefit under Medicare. There are millions of them out there. Seniors will tell you they are not worth the paper they are printed on. The reality is for the next 2 years, seniors like Bob will be left with virtually nothing. He gets a card. If Bob were low income, next year he will receive a debit card worth $600. Consider this. Bob gets a debit card worth $600, but what happens when Bob is going to the drugstore and he is getting his prescription drugs. It is now July and he goes to the pharmacist for his refill and the pharmacist says, sorry, you are out of money. The $600 is used up. What does he do then? He goes back and he sees his friend Fred, and Fred says, Well, I am still going to the drugstore and I am getting mine free. Bob wonders why he does not get his. Wait until that hits next year. Wait until your constituents start calling you up because their debit card has run out of money and it is July or August or September. Now he has the card for a couple of years. After 2 years of having the card, it expires. It is done for. Now Bob is going to be forced to wade through hundreds of pages of health plan documents to choose which plan he wants. I decided to look at some of the plans that are out there and here are three of them. Here is Care First, Blue Cross Inc. Anyone want to try wading through this? Anyone want to read that and understand what is in there? I am a lawyer, probably not very good, but I have trouble reading that. Here is another one from the Kaiser Foundation Health Plan of the Mid-Atlantic States. Bob will have to wade through this one, too, to figure out what he wants. Here is one from MDIPA. This is a little smaller than the others but still pretty daunting. In a couple of years, Bob will get a couple of these and he will be told to decide which he wants. He has to read through them and figure it out. What is he going to do, hire an accountant; hire a lawyer to figure out which plan is best for him? The plans could have different benefits, different rules, different prices, and different drugs. Once Bob makes his choice, he could find out some of the drugs he needs are not actually covered by the plan. So he either has to change drugs or what, change plans? No, Bob cannot do that. He can do that at the end of a year. But if he finds out his drugs are not covered, he cannot switch. He has to wait until the end of the year. If Bob chooses one of the new PPO plans, the preferred provider plans, he might even have to change doctors to become part of it because they will list only certain doctors. If that is not enough, once Bob chooses a plan and he is in it, his monthly premiums may skyrocket past $35 a month at any point in time. I have said to some people, That cannot be right; surely they cannot do that. But it is in the bill. It is in the 654-page bill. If you belong to a plan, any time that plan wants to raise the premium, you have to pay it. You cannot get out of the plan. You have to stay in it. So you have signed up for a plan. It says it will charge $35 a month. After a couple of months, the plan figures out it is not making enough money and now the premiums will be $45 a month. Why, you can write your Senator and tell your Senator how unfair this is. Guess what. Your Senator cannot do a darn thing about it. Nowhere in this bill does it guarantee seniors will not have to pay different monthly premiums. Senator Daschle offered an amendment to try to fix this significant problem so seniors would be guaranteed some protection from fluctuating monthly premiums but, again, the Republicans said no. So we are supposed to vote for a bill that cannot even tell seniors what they are getting and how much it is going to cost them. In fact, Senator Lott, who was quoted in the New York Times this week, said: You are going to make a huge change in an entitlement program and you don't even know how it would work, if it would work. At least we have one Republican over there who recognizes this as a bureaucratic maze. At least the amendment of Senator Daschle would have given seniors some peace of mind that what they bargained for is what they were going to get. So we are back to Bob. Now, Bob is in the plan. His premiums might skyrocket. He might find that the prescription drug coverage is unaffordable. Now Bob is down at the coffee shop with his friends. None of them make very much money, but their income levels vary a little bit. They are all basically the same. They are retired, they worked hard all their lives, and they are spending a little time watching their grandkids grow. None of them are wealthy. They weren't born with silver spoons in their mouths. They don't have a lot of stock. They are just getting by. You know, you see them on Main Street all the time. You see them in our towns, all over our States--average, middle class elderly Americans--and they are down at the coffee shop. They start talking. Bob finds out that all of his friends pay different amounts for their prescription drugs. Bob's friend George is paying a $50 deductible. Bob says, ``How can this be?'' Well, George earns just a little less than Bob. He earns $14,000 a year. So he pays a $50 deductible. He pays a lower premium and 10 percent copay for most of his drugs. Their other friend Joe makes a bit less money a year. He is getting around $12,000 or so a year. He pays no deductible, no premium, and a 5 percent copay for his drugs. Bob is sitting there and he is astounded. He doesn't make much more than they do. He makes $15,000 a year. He is struggling to make ends meet at that, and he is still stuck paying 50 percent copays, large deductibles, and large premiums. Think about how you are going to hear from your seniors who gather at the local McDonald's in the morning to have their coffee and they start talking about this. One gets drugs practically free. Someone making just a few hundred dollars more pays the full premium, the full deductible, 50 percent copays. Try explaining that to your elderly citizens when this hits the streets. Seniors are going to know immediately that this is not fair. This is the first time in Medicare's history that we are means-testing the program, where seniors are treated differently under Medicare. I believe there are serious consequences to creating this welfare class in Medicare, and that is what we are doing. We are creating a welfare class under Medicare. It will be incredibly confusing for seniors to have four tiers of differing benefits. Seniors will not know where they fall in these income classes. Think of it, there are four. You have 75 to 100 percent of the poverty level; you have another class from 100 to 135 percent of the Federal poverty level. You have another class from 135 to 160 percent of the Federal poverty level. And now you have another class above 160 percent of the poverty level. There are four different classes. How does Bob know where he fits? He is going to have to go through some tests. He is going to have to fill out some forms and submit the forms so people know how much money he makes. I had some of those forms here. Here they are right here. Here is a set of forms right now for the Commonwealth of Pennsylvania. It is 16 pages long. It is what a person has to fill out in the Commonwealth of Pennsylvania to show they are poor, if I can use that word, that they are low-income, that they need some assistance, some benefits. This is the kind of paperwork they fill out. Here is all the information about you: where you live, what you do, what you have done in your lifetime. Any cash on hand? Any savings accounts? Any checking accounts? Any certificates of deposit? Any stocks or bonds? A boat? Do you have a Christmas or vacation club? Does anyone own or is anyone buying a car, truck, or motorcycle? You have to fill it in--the year, make, and model. Do you have a life insurance policy? Do you own a burial space or burial plot? This is what the elderly are going to have to start filling out. And guess who gets it. Where do they take this? Let's say Bob's friend George--how much did I say George is making? He is making about $14,000 a year. He has to prove that. He has to prove it by filling this out. Who does he give it to? The IRS? No. Does he give it to his Senator? No. How about his Congressman? No, he doesn't give it to the Congressman either. He gives it to his pharmacist and his doctor. So, now, our pharmacists all over America are going to have to keep all this stuff on file. Now they are going to have to look through it to make sure that George didn't make a mistake somewhere in filling this out. Think what is going to happen to elderly all over America who now say: Wait a minute, I don't necessarily want my pharmacist to know all my business. The pharmacists are going to say: I don't want all this paperwork. Wait until that hits the streets. More paperwork for our pharmacists, more paperwork for our elderly. And they aren't going to know how to fill this out. Not only that--assets. What if George, let's say, or George and Betty, husband and wife, fall just slightly below the $19,000 level in both incomes. So they go to fill out this paperwork to get a cut in their drug coverage, to get a better benefit. But then they hit that page on assets. What kind of assets do you have? I know people are going to laugh about this, but this is true. Betty is going to have to have her wedding ring appraised by somebody. How much is it worth? How about family heirlooms? Let's say George and Betty had some furniture that their grandparents passed down. It is now an antique, worth some money. How much is it worth? I said the other day, it seems to me this portion of the bill is going to be a boon to the pawnshop artists around America. They are all going to be called out to assess things and determine how much they are worth. Who is going to pay that bill? That is in the bill. You may think I am joking. It is in the bill, an asset test, and it includes things such as jewelry and furniture and, yes, even a burial plot. We are forcing this humiliating process on seniors, to prove they are poor, by filling out this complicated paperwork--an assets test. Finally, after all of this trouble, if Bob and his friends' health plan does not make enough money off of them, they will just pull out of the market, leaving them right back where they started. We have seen this happen time and time again with Medicare HMOs all over the country. It could happen over and over and over again as the new private, drug-only HMOs come in and pull out. The Federal fallback may be available one year but not the next. So seniors will be bounced from one plan to another plan, maybe back to Medicare, maybe to another plan. There is nothing to stop it. And if a plan is in there, and it is not making money, they are out of it. So I guess I could ask, by now are you confused? Is it a little tough to follow what all is going to happen? Imagine how our seniors are going to feel. Senator Clinton prepared this chart. I looked it over, and it really does kind of give you the complexity of this bill we are talking about. I will not go through it all except to say that seniors starting here, in private plan ``one,'' with a $40-a-month premium, $275 deductible, 47 percent coinsurance, no limitations on doctors-- well, let's say you join this plan and then find out the drugs you need are not offered there. You file a grievance. It goes to a hearing to see whether the drug is covered. Then, let's say it is a private plan, and it doesn't make enough money, and they drop out. Then you fall back into the Federal fall back and you start all over. It is a maze. That is what we are asking our seniors to get involved in. Keep in mind that over one-third of all seniors will have to navigate this maze--just to lose money. They have to go through this just to lose money. One-third will go through this maze, and they will pay more in than they get out. I suspect very strongly that this whole thing was developed by people who want the system to fail. They want it to fail. This bill is an example of ideology over fact, placing all the bets on private health plans to provide the drug benefit to seniors. It is especially bad for seniors in rural States where private plans have shown no interest in participating in the Medicare Program. This private-sector worship is derived from the belief that the free market will take care of everything: The free market is the answer to everything; if only it is just put on the free market. Well, private enterprise or the free market does very well, thank you, when you are doing automobiles or airplanes or wicker baskets or widgets, clothes, glasses, watches, television sets, computers, and a host of other things. That is where the free market works. But the free market, the private sector, by its very nature, leaves those people behind who are not profitable, people such as those with disabilities, mental illnesses, and the elderly. The free market did not break down the barriers to people with disabilities in our country. It was this Congress and a President and the Americans with Disabilities Act that said: No more; we are going to provide opportunities and openness in our country to people with disabilities. It was not the free market because people with disabilities simply are not profitable. Why do you think we have health care coverage now under Medicare and private health care plans for physical illnesses but not for mental illnesses, for which we have been trying for a long time to get parity? People with mental illness are not profitable. And why do we have Medicare? Because a long time ago the private insurance companies found out that the elderly were not very profitable either. And I speak about this from personal knowledge. When I was a senior in high school, in the small town of Cumming, IA, population 150, my mother had passed away some years before. We were a bunch of bachelors living in a house. My father was 74 years old. It was 1958. He worked most of his life in the coal mines, and he had then what they call miner's lung, also known as black lung. He had a couple of injuries. He was not in very good shape. He had no stocks. He had no bonds. He owned no property. He did not own anything. His total income--total income--per year was less than $1,500 because, thank God, during World War II, he had worked for a while and got covered under Social Security. See, before that he had worked all his life, and there was no Social Security. But, fortunately, during World War II he worked a little bit, and got covered by Social Security, so he was getting about $1,200 or $1,300 a year. Actually, he got a little more than that because he had kids under the age of 18, me being one, and Social Security gave him a little extra, $35 a month. So here was my dad. He was 74. He was in bad shape. He had no assets, no money. There was no Medicare out there, folks. There was nothing. Could my dad afford to see a doctor? No way. And my father did not see a doctor. But every year, like clockwork, in the middle of the winter, my dad would get sick. It happened every year. He would get sick. He had this bad lung problem. He would catch a cold, and he could not get over it. He would get pneumonia, and we would get a neighbor, with a car, and rush him to Des Moines to the hospital. They would put him in a tent, dry him out, get his lungs down, and cure his pneumonia. They would send him home after a couple weeks. How did we afford to do that? We did not have anything. I will tell you how we afforded it. Thank God for the Sisters of Mercy at a Catholic hospital in Des Moines, IA, who gave us charity because he did not have anything. That is the only way that my father got health care. Now, why didn't some insurance company rush out to cover him at a price he could afford? Keep in mind, he was making less than $1,500 a year. He was not profitable. He was 74. He had black lung disease. He had a couple of other illnesses and injuries. My father was not profitable to an insurance company. I can remember like it was yesterday when I came home from leave from the Navy. This was later on in 1966. I came home on leave from the Navy to see my father, who was now nearing his 80th year of life. I remember when he showed me his Medicare card and said: Now I can go see a doctor. I can go to the hospital if I have to. And I don't have to take charity anymore. I often wonder, what would my father's later years have been like, what would it have been like if he had had Medicare earlier on? How much better his life would have been, how much healthier he would have been, how much more he would have enjoyed in his elder years if he had had decent health care. So I don't want anyone lecturing to me about how wonderful the private market is for health care for the elderly. Go tell it to somebody else, but don't tell it to me because I lived through this. That is why when someone tells me that the private sector is somehow going to take care of the elderly, I say: Wait a second, maybe the elderly who have a lot of money, but how about those at the bottom? That is why I say what we are doing here is setting up a welfare class. Once again, people like my father will have to fill out paperwork and beg, ask to be put in a system they can afford. I guess we haven't learned anything around here. We haven't learned a thing. Maybe we have too many people here who didn't go through what I went through. I don't know. I don't know everybody's situation. I would like to think if people went through with their fathers what I went through with mine, they might have a different perspective on Medicare. There is no reasonable rationale for relying on private health plans for prescription drugs for the elderly, even in monetary terms and costs. We know administrative costs are much lower in Medicare. We have a history. The administrative costs in Medicare are between 2 and 3 percent a year; in private health care plans, 15 percent per year administrative costs. We also know that over the last 30 years, Medicare spending has grown at a slower rate than private health care plan spending: 9.6 percent compared to 11.1 percent. Here is a story that appeared in the Washington Post recently. It is entitled ``Bush Pushes for Expanded Private Role in Medicare.'' It reads: President Bush yesterday renewed his call for market competition to play a large role in Medicare's future, as the Senate wrestled over how far to go in encouraging private health plans to deliver care and prescription drug coverage to older Americans. Bush disparaged a core tradition of Medicare in which the federal government has determined what medical services are covered and how much government pays doctors and hospitals to provide them. He said Medicare would be more effective if ``health plans compete for their business and give them the coverage they need, not the coverage that a Washington bureaucrat thinks they need. Well, with all due respect, President Bush never lived through what I lived through. His father never had to rely on charity for health care like my father did. So he can disparage Medicare because no one in his family ever gave a hoot about Medicare. They didn't need it. He has turned a cold shoulder of indifference to those who rely on Medicare. But not only that, the President ignores history. He says the private sector can do it better. Wait a second. We have a history. We have facts. We don't have to rely upon rhetoric. We have facts. Administrative costs in Medicare, 2 to 3 percent; private health care plans, 15 percent. OK, which is more efficient? In the last 30 years, Medicare spending has grown at a slower rate than private health care plan spending has grown. So what is he talking about? What is the President talking about when he says the private health care plans can do it better? We have a history. We have facts. We have data. That private sector, when it comes to the elderly, does not do it better. When it comes to this private plan program, it means there is going to be less money available to actually help seniors get prescription drugs. Billions will be wasted on advertising, marketing, glossy brochures, higher payments to private plans, billions of dollars that should be going directly to seniors. And how about CEO salaries? We haven't talked about that. All these private health care plans, they pay a lot of money for their CEOs. That is fine, if they are in the private sector. But that is money that is going to be siphoned off. Last year, the drug companies in America spent more money on advertising than they did on research. Wait until this plan gets out there. I say to every senior citizen listening to me give this talk: Get prepared. You are going to get a lot of mail in your mailbox. You are going to get a lot of brochures for this drug and that drug and this plan and that plan. You are going to get inundated with advertisements, and you are going to see them on TV. You think you see a lot now. You wait, you will see more. Why? Because now they have all this money. I understand we are about to have an amendment that is going to provide $6 billion to the private companies to entice them into providing these plans. If they are so doggone good, why do we have to do this? ``Senate GOP Eyes Billions to Encourage Private Plans, Employers.'' I am told it is going to be $6 billion. We haven't seen it yet. Whether it is $6 billion, $5 billion, $4.5 billion, I don't know. Whatever it is, it is too much. I mean if President Bush is right and the private sector can do it better, why do we have to bribe them? Why do we have to bribe them with taxpayers' money, $6 billion, come on and get it? Talk about hogs feeding at the trough. This is it, folks. Six billion dollars, I am told. Well, maybe $5.5 billion. I don't know what it is. But they are going to give it to entice them into this program. Why are we robbing seniors to cushion the pockets of private plans with billions of dollars of a subsidy? ``President Bush Pushes for Expanded Private Role in Medicare.'' Well, you kind of see it all coming together. The President, Republicans are pushing for all these tax breaks for their wealthy friends. And now they reward the drug companies. No cost containment at all. Let the drug companies keep boosting their prices year after year after year. And guess what. We will just keep raising the premiums on seniors. Now we get the private plans in with their expensive CEOs, their expense accounts, and we are going to bribe them with $6 billion. What a deal. Tom Scully, the Bush administration's top Medicare official, called Medicare ``an unbelievable disaster'' and ``a dumb system'' during a recent meeting in Pennsylvania. The third-ranking Republican in the Senate, Senator Santorum from Pennsylvania, said: I believe the standard benefit, the traditional Medicare program has to be phased out. Senator Robert Bennett of Utah, on March 1: Medicare is a disaster. Medicare will have to be overhauled. Let's create a whole new system. Of course, we all remember the immortal words of our former House Speaker, Newt Gingrich. He didn't want to kill Medicare, he just wanted to let it ``wither on the vine.'' So let's get this straight. Seniors are telling us not to privatize Medicare; 89 percent have already voted to keep traditional Medicare. They tell us they want a less expensive, more reliable, straightforward, simple benefit, guaranteed to be there. The facts tell us that privatizing Medicare doesn't work. We have the facts. So why did the administration, in this bill and the House bill, insist on this privatization? Because it is the first step toward total privatization of Medicare and, I believe, the first step toward privatizing Social Security. Senator Stabenow offered an amendment I supported which would have guaranteed a Government fallback in every area of the country, so that seniors could choose traditional Medicare regardless of what private plans are offered. As we said on the Senate floor that day, this bill offers two private plans. Senator Stabenow wanted to say: OK, we will give them more choice and offer a Medicare plan. Let them all compete. The Republicans said no. They want only to have two choices for seniors between two private plans. But they don't want to let seniors be able to choose Medicare, which they have already shown. As the Senator from Michigan stated time and time again on the Senate floor, 89 percent have already chosen Medicare. Yet somehow we are turning a deaf ear to them. It seems to me we have a lot of talk around here about choice, but they don't want to let Medicare be one of those choices for seniors. The only choice in the bill is for HMOs and private plans. They will be the ones choosing your premiums. They will be the ones choosing your options. They will be the ones choosing your benefits. Well, you tell that to my seniors back in Iowa who have never had a private option. The Republicans say they want to provide seniors with choice. They claim seniors should get the same type of benefits we in Congress get. Well, all right. Let me tell you what I have for drug coverage. I pay 25 percent for my drugs. That is it. I go to the drugstore and I pay 25 percent. What a nice deal; simple, straightforward. Seniors won't have coverage anywhere nearly as generous in their plan. Look at it this way. If this plan provides $400 billion over 10 years, which is what it does, CBO has estimated that senior drug costs over the same period of time will be $1.8 trillion. Figure that out. We are providing $400 billion. The estimated drug costs are going to be $1.8 trillion, and that is probably on the lower side. That means we are leaving the seniors to cover 78 percent of the tab for drugs. I get 25 percent; seniors have to pay 78 percent. You are going to tell me that is fair? Again, there is a storm coming, when the seniors in this country find out what is in this bill and how it affects them. So why the insistence on privatizing Medicare? Well, I think the answer is clear. Congress is choosing a special interest over seniors' interests by following ideology over facts. I said earlier today there are three reasons we are passing this bill. The first reason is because the drug companies want it. The second reason is because the drug companies want it. You guessed it, yes. The third reason is because the drug companies want it. You might think, from my comments, that I have it in for the drug companies. Nothing could be further from the truth. I have fought for years on the floor of the Senate for more money for research--the kind of basic research that is done through the NIH, done in coordination with drug companies, taking some of that basic research and investing their own money in these drugs and bringing them to the marketplace. Some of them have been wonderful. We are making new strides in drug development every day. I have a lot of respect for our drug manufacturers who have brought a lot of these drugs to market. However, that does not mean my esteem for the drug companies would compel me to vote for a bill that will continue to allow them to make the kind of profits they make on the backs of our senior citizens who are on fixed incomes. No, in this one case, in this area--this is where Medicare ought to provide the drug benefit. It is where Medicare--just like we do in the Veterans' Administration--ought to be the one bargaining for the prices for our elderly. Let me and the others who can afford health plans, and pay generously for them, pay the drug companies, not the elderly. So, again, drug companies stand to gain billions of dollars from this drug benefit--trillions.

Mr. HARKIN. Without losing my right to the floor, yes.

Mr. HARKIN. I think the Senator knows the answer to that question. He and I have both fought hard in this Chamber for veterans benefits. I yield to no one in my support of those who have put on the uniform of this country to defend our flag, to defend our way of life, and I know the Senator from Illinois will take a back seat to no one also in that effort. We fought hard to get a veterans drug benefit that had cost containment. That is what it does. Today, I am proud to say--I am proud--because of what we fought for here, the veterans in this country today get the cheapest prices on drugs of anyone in our country. I am proud of that fact, and they deserve it. Has it ruined the drug companies? Of course not. They are selling more drugs. Maybe they take a little bit less profit, but they are selling more drugs because now people can afford to buy them. That is what we need today. We need that kind of system Medicare could provide in dealing with the drug companies for big purchasing, bargain down the prices so the elderly can get the same price on drugs as our veterans. I ask rhetorically a question of the Senator from Illinois.

Mr. HARKIN

Mr. HARKIN. Mr. President, it is with great sadness that I pay tribute to Janine Johnson, who for over 12 years served the Senate, its Members and staff as an assistant counsel in the Office of Legislative Counsel. Janine died on May 29, 2003 at the far too young age of 37. In reality, there is little my words can add to the memorial Janine herself built through her outstanding legal skills, extraordinary dedication and uncommon kindness and personal grace. She will be remembered for her positive impact on the laws she helped so much to enact and for the example and fond memories she has left her colleagues and friends. Janine came to work in the Senate Office of Legislative Counsel with an already full set of accomplishments: first in her high school class of 333 in Winchester, Massachusetts; National Merit Scholar; cum laude graduate of both Harvard College and Harvard Law School; a federal circuit court clerkship with Judge Cecil F. Poole on the United States Court of Appeals for the Ninth Circuit; member of the Massachusetts Bar. We are fortunate that Janine built on that record by bringing her excellent qualifications and talent to the Senate. Beginning in February of 1991, she drafted many bills and amendments for committees and individual members and their staffs. Her work, which was primarily in the areas of the environment, public works, agriculture, nutrition and natural resources, contributed to a long list of enacted legislation. In addition to numerous environmental and public works laws, including the Water Resources Development Acts of 1996 and 2000, and the Transportation Equity Act for the 21st Century of 1998, Janine contributed greatly to writing the Federal Agriculture Improvement and Reform Act of 1996 and the Farm Security and Rural Investment Act of 2002. And though her efforts helped better our Nation, and even other parts of the world, only a very few people have any idea or appreciation of Janine's work. That is just the way Janine would have it. She was a private person who did not seek the limelight. Instead, she quietly went about doing excellent work as the consummate professional she was. She was meticulous, detail-oriented and precise, as one would want someone drafting important legislation to be, with an uncanny ability to take concepts and ideas and shape them into exact language carefully crafted to fit into the federal statutory scheme. To cite an example, Janine was the lead legislative counsel in drafting the nutrition title of the 2002 farm bill. Especially in a bill as extensive and complex as the farm bill, it is the rule that drafting errors are to be expected. To this day, not one error has been found in the drafting of the 2002 farm bill's nutrition title. Janine willingly put in the extra hours so often required to produce such high-quality work while meeting the demanding time constraints of the legislative process. She was a very patient and stabilizing force in what are frequently pressurized circumstances--someone who also took pride in cultivating and maintaining good relations with both sides of the aisle and all sides of the various issues she worked on. In short, Janine Johnson exemplified the fine professional qualities that are characteristic of the Senate Office of Legislative Counsel. She distinguished herself by setting a high standard within an office known for its high standards. Janine's death is a terrible loss, and yet as we consider her very substantial and lasting accomplishments and contributions--and more importantly the memories of her that live on--it is fitting to recall the words of John Donne: Death be not proud, though some have called thee Mighty and dreadfull, for, thou art not so, For, those, whom thou think'st, thou dost overthrow, Die not, poore death, nor yet canst thou kill me. I offer my condolences and kind wishes to Janine's family, friends and colleagues as they mourn her passing.

Mr. HARKIN

Mr. HARKIN. Mr. President, I want to put into the Congressional Record a statement I made last year shortly after we lost a great friend of mine and a true American success story, Danny Piper. Danny Piper came into my life 13 years ago. I was the Chairman of the Disability Policy Subcommittee here in the Senate, and was the sponsor of the Americans with Disabilities Act. We were having a series of hearings leading up to the hopeful passage of this bill. Danny became the first person with Downs Syndrome to testify before a congressional committee. I can't remember exactly how this came about, but I am sure that Marietta Lane, Paul Marchand, and Bobby Silverstein had something to do with finding Danny and getting him and Sylvia and Larry to Washington. I can remeber that day like it was yesterday. Danny was cool, composed, and very confident as a witness. I spoke with him later, and asked if appearing before the Senate was like being in his high school play. ``Not so bad,'' Danny replied. I followed Danny from then on. I was so proud when he got his high school certificate, then got his first job. In fact, I spent one of my ``workdays'' at the store with Danny. He showed me the ropes.'' He showed me the correct way to stock shelves. He made sure I knew how to load the cardboard box machine so I wouldn't get hurt. We went to lunch together, and it was a day I will always cherish. Evey once in a while I would run into Dan in one place or another. He always hailed me as ``Hi, big guy.'' Once, I was visiting a school in Ankeny during the summer, and I was to meet with some teachers and administrators. To my surprise, when I entered the room, there stood Dan. So he gave me his usual, ``Hi, big guy'' routine. One of the older persons there said, ``This is Senator Harkin.'' Dan just sort of shrugged, and said, ``Yeah, yeah, I know . . . big guy''. This memory still makes me smile. Dan was always a part of all my campaigns, always there for my announcements and always there for the victory parties. But perhaps my most cherished moment with Dan was this spring. Dan set another first, I believe, when he introduced me at my announcement for reelection before a bank of TV cameras and a couple of hundred people. Sylvia told me how hard he practiced for this, and I could tell. He was poised, but a little nervous as he forgot to introduce my wife, Ruth. I told Dan it was no big deal, I still forget to do that sometimes myself. But he gave that introduction without missing a beat. He had it down pat. I was so proud and honored that Dan would do that for me. Sylvia and Larry, their family were pioneers in every sense of the word. Long before it was even grudgingly accepted, they made sure Dan was fully integrated in with his peers in school, made sure he was not ``sent away'' like my brother was so many years ago, to an institution where everyone was ``just like him.'' Dan was a pioneer, also, challenging a system that wanted to deny him his individuality, deny him his personal hopes and dreams, deny him his independence, deny him his human right to meet challenges and set goals for himself. When we visited Dan in the hospital, I was so certain that he was going to make it. He had that same positive upbeat attitude I have always known. He was looking forward to helping me again this fall, as he had always helped me. Well, Dan, a tragic accident has meant that you will not be with us physically. But the most powerful thing about you, Dan, was your spirit, and that will always be with us who were touched by your life. Your spirit commands us to lead on, break down barriers that separate us, provide that ladder or ramp of opportunity for all. We will enact MICASSA into law, Dan, and your example of overcoming challenges and meeting goals compels us not to fall in this endeavor. Thank you, Dan, for all the help you gave us during your brief life. You helped us to be more understanding, more generous and more caring toward one another. That is a great legacy. In whatever lies ahead, you will be often on my mind, and always in my heart.

Mr. HARKIN

Mr. HARKIN. Mr. President, I thank my colleague from North Carolina for offering his amendment of which I am a cosponsor. Every time I go back to Iowa, I hear from consumers and others: Why do I get inundated with all these ads, and I cannot buy them unless I go to the doctor? Right now, the drug companies are spending more on advertising every year than they are on research, and we wonder why the price of drugs keeps going up. This all changed a few years ago. If my colleagues will remember, before 1997, we did not see all these ads. Now it is time to cut out this massive advertising of drugs that we cannot even buy in the marketplace.

Mr. HARKIN. Mr. President, parliamentary inquiry: What type of time agreement are we under now?

Mr. HARKIN

Mr. HARKIN. Mr. President, I am proposing this amendment, which would enact into law the ``Money Follows the Person'' rebalancing demonstration project. This project was part of President Bush's 2004 budget request. It is a critical component of President Bush's new freedom initiative. This really is about freedom. It is about the freedom of people with disabilities to enjoy the same opportunities for employment and community living that are available to all Americans. A number of years ago after the passage of the Americans with Disabilities Act, a number of us began working on what we considered to be the next step in trying to provide for a more open environment for people with disabilities. And that was to get more people out of confined living--nursing homes and institutions--and put them into community-based living arrangements. The bill we have been working on to do that is called MiCASSA, which is the shorthand for the Medicaid Community Attendant Services and Support Act. I have been working on the bill for 10 years. In fact, I note for the record that the first introduction of this bill took place in the House in 1997 and was introduced by none other than the Speaker of the House Newt Gingrich. It was first introduced in the Senate in 1999, and I was the chief sponsor of it at that time. My amendment basically would take what the President suggested in his budget and make it operable. My amendment would take the President's proposal for giving grants to States to transition individuals into community-based living under the existing Medicaid program. Under the President's proposal, the Centers for Medicaid and Medicare would give out to States $350 million per year for 5 years. This money would pay 100 percent of the cost for community-based services for the first year after individuals with disabilities move out of an institution or a nursing home. After that time, the Federal Government would pay its regular Medicaid rate. This amendment and the President's proposal was for a demonstration program for 5 years. So the total cost of this will be $1.75 billion over 5 years, and it will end because then the States would go back to their normal process and procedure. The idea behind this is to give States the upfront money they needed to get people with disabilities out of nursing homes and get them into community-based living. I believe the President proposed this initiative because he recognized that, unfortunately, under current Federal Medicaid policy, the deck is stacked in favor of living in an institution. For example, right now under Medicaid, States are required to provide nursing home care, but they are not required to provide home and community-based services. Data from 2001 indicates that 70 percent of Medicaid funds are now being spent on institutional care and only 30 percent for community- based care. That is a shameful statistic that needs to change. As the administration's documents state, this initiative would ``level the playing field.'' Some might argue this is a Medicare bill and we should not include a Medicaid initiative. However, there are other Medicaid provisions in this Medicare bill, presumably because they are important to some of our colleagues. This amendment, I believe, is just as worthy, and I would argue more so because it helps fulfill our goals in passing the Americans with Disabilities Act 13 years ago. In fact, the 13th anniversary of the Americans with Disabilities Act is coming up on this July 26. Thirteen years ago we made specific findings about institutionalization and the continued segregation of individuals with disabilities. I was one of the leading sponsors of the Americans with Disabilities Act, and I know firsthand the effects of segregation of people with disabilities. I told the story often about my brother Frank. When he was a young boy, he became deaf because he had spinal meningitis. He became totally deaf. They picked him up, took him away from home, and sent him halfway across the State to a segregated school for the deaf. The people referred to it as a school for the deaf and dumb. As my brother always said, I may be deaf, but I am not dumb. That is what it was like in those days. It continues on today, that people with disabilities are segregated and sent to live in institutions. A couple of years ago, 1999, a very famous case made its way to the Supreme Court. It is referred to as the Olmstead case. The Supreme Court ruled in 1999 that confinement in an institution is discrimination. The Supreme Court stated that when you segregate someone, as was being done in Georgia--and this case just happened to originate in Georgia. I am not picking on that State, but it happens in all other States. This Olmstead case just happened to originate in Georgia. When the Supreme Court looked at the case, they said when you segregate someone, you are telling them they are ``unworthy to participate in community life.'' That is the Supreme Court decision. That Supreme Court decision said that States must offer the least restrictive environment to people with disabilities. The problem is, 4 years later after the Supreme Court ruling, there are still countless Americans with disabilities institutionalized, needlessly institutionalized. This amendment is a win-win program. It would not only help offer more choices to people with disabilities, it would provide the resources to States during a very difficult fiscal time. Studies have shown States that rebalance their long-term services system can realize substantial savings. The Lewin Group did a study of three States that increased their use of home and community-based waivers instead of nursing homes in the early nineties. In one year, Colorado saved $42 million, Oregon saved $49 million, and Washington saved $74.5 million. The researchers explained these States were able to get such high cost savings by targeting people with disabilities who were very likely to go into a nursing home. In our amendment, we are targeting those who are already in an institution or nursing home. So States are already spending large sums of money on these people. Based on data provided by the Congressional Research Service, nursing homes cost approximately $57,000 per year per person. Institutions for individuals with mental retardation cost $88,000 per person per year. Home and community-based waivers are roughly $30,000 to $50,000 cheaper per person than these institutional cases. The problem is States cannot afford the upfront costs that are needed to move people out of institutions and into community-based living. For example, housing may need to be modified to be accessible. That costs money. An individual may need some education and services to get ready to move out of an institution, especially if they have been there a long time, say, 20 years or more. The State may need resources to develop sufficient community providers and rebalance its long-term service program. There are a lot of upfront costs a State would have to do to get someone with a disability out of a nursing home, out of a State institution, and into a community-based living environment. The amendment I am offering implements President Bush's own budget request for 2004. It will be an upfront investment to help these States do that transition. It is a demonstration program for 5 years to those States that need the help. I applaud the President for proposing this program as part of his new freedom initiative because it really is about freedom: The freedom to live with family and friends, not with strangers; the freedom to take a walk in one's own neighborhood, not just on their ward; the freedom to be a person and not a patient. No one should have to sacrifice their freedom to participate in society because they need help getting out of the house in the morning or assistance with personal care or some other basic service. Think about it. That is what happens to people with disabilities. They sacrifice their freedom to participate in society because they may need a little help in the morning, a little bit of help at night, or a little bit of attendant services. As taxpayers, we know it is cheaper for us to provide that kind of home-based, community-based service rather than putting people in institutions. But back when we built the institutions, when we started the nursing home care for people with disabilities that is what we believed, that people ought to be segregated. We have changed as a society, and I think we have changed for the better. It is not unusual now to see people with disabilities in all walks of life, working on the Senate floor, in our court systems, on the shop floor, running businesses, shopping in the store, eating in a restaurant, going to an amusement park. I argue what is unusual is that in the year 2003, to say we are going to take taxpayer money and we are going to institutionalize someone with a disability who does not want to be institutionalized, who would rather live in the community, who would like to go out for a walk in the daytime, who might want to go down to the corner store and purchase some things, who might want to go to a movie now and then. Recently, I received a letter from someone who had been moved to community-based living. She said she went to a movie for the first time in 3 years. Think about that. It was the first time in 3 years because she had been in an institution and she could not go to the theater. Now she can go to the movie theater. I hope Senators will think about this. As I said, it is in the President's budget. He has requested it. I have offset it. So I can see no reason we should not take this step to make sure people with disabilities can get back into the community where they belong and where they want to be, with their family and friends, and not shut up with strangers, with people they may not know, segregated from society. I urge my colleagues to act now. Freedom does not need a lot of debate and discussion. The freedom for people with disabilities ought to be happening right now. I yield the floor.

Mr. HARKIN. Mr. President, I ask unanimous consent that further reading of the amendment be dispensed with.

Mr. HARKIN. Mr. President, I have an amendment at the desk and ask for its consideration.

Mr. HARKIN. Mr. President, I have no objection. I ask unanimous consent that I be permitted to offer my amendment which will only take a few minutes after the Senator from Washington finishes her amendment.

Mr. HARKIN. Reserving the right to object, I did not hear the request.

Mr. HARKIN. Reserving the right to object, might I inquire of the Chair what is the procedure after the vote?

Mr. HARKIN

Mr. HARKIN. Mr. President, I too wish to pay tribute to the accomplishments of Ms. Bonny O'Neil and thank her for her many years of dedicated service to the U.S. Department of Agriculture. Ms. O'Neil has done an outstanding job as the senior career official responsible for the Food Stamp Program. Under her very capable leadership, this important program has been greatly improved. During the writing of the recent farm bill, which took almost 2 years, Ms. O'Neil worked tirelessly with the Committee on Agriculture, Nutrition, and Forestry on the food stamp provisions. Her expertise in this area was invaluable and she was always available to provide assistance. After the Farm Security and Rural Investment Act of 2002 was signed into law, Ms. O'Neil worked to implement the food stamp provisions, including the large number of State flexibility sections contained in the act. The quality of her efforts in this regard are obvious. In the one year since the farm bill passed, numerous States have already implemented or are planning to implement important State options that significantly improve the Food Stamp Program. As a result, we are helping working Americans in their efforts to enter and stay in the workforce and also making sure that, for millions of American children, the shadow of hunger does not loom so darkly. In always remembering that her job is to serve Americans and to better their lives, rather than just to run a program from an office in Washington, Bonny meets and surpasses the highest ideals of civil service. I thank Ms. O'Neil for her years of service to our Nation and wish her well in her retirement.

Mr. HARKIN

Mr. HARKIN. If the Senator will yield for another question, I thank the Senator for yielding again. The Senator continues to make an excellent point here that seems to be lost on the proponents of this bill on the other side. I continue hearing how this is a bill that is supposed to promote competition. It is supposed to promote free enterprise and the marketplace. Yet here, as the Senator from North Dakota has pointed out, in one place where the marketplace really could save seniors money, by opening up the marketplace for these drugs to come in from Canada as long as they meet all of our FDA requirements, on this the other side says, no, we don't want the marketplace to work in this case. It kind of gives lie to all of the arguments about how this bill is to promote competition in the marketplace on drugs for the elderly. Quite frankly, it seems to me this bill is to promote higher prices and to ensure the elderly really do not get the best deal they could possibly get in buying prescription drugs which would mean they would not be able to buy them from Canada, which distorts the marketplace. Again, I thank the Senator for his well-reasoned arguments and his well-reasoned amendment. With this amendment, we ought to strike a blow for the marketplace and let the marketplace work by allowing our seniors to be able to purchase these drugs under this so-called free trade agreement that we have with Canada. I compliment the Senator from North Dakota for this amendment.

Mr. HARKIN. The Senator really has made an eloquent case for why we ought to have free trade with Canada in drugs as long as they meet the same requirements. I ask the Senator, do we not in fact have a free trade agreement with Canada?

Mr. HARKIN. Will the Senator yield for a question?